FINALIST

A secondary market in bonds allows us to track how the probability of the event changes over time, since the price at the margin for a bond on the secondary market is the most accurate assessment of the probability of an outcome we could wish for. [...] In this case, the manufacturer is appropriately rewarded for their innovation and ambition for patients, but only when this reward makes sense in the context of the value of the drug over time; the value of EX-T increases as clinical experience of the drug increases. [...] It may also be appropriate to impose a PBR-style rebate in the event of a negative trial result, for example paying the difference between the premium the manufacturer obtained for their innovation and the cost of the next- most expensive drug. [...] Indeed, we’d expected the bonded reimbursement submission to be particularly valuable in cases where the manufacturer has a lot of latent knowledge – which is precisely the situation where the manufacturer would be most able to undetectably affect the outcome of the trial! It is likely therefore that the triallists for the definitive trials would be well- regarded neutral academic groups, who rece. [...] One strong suggestion for what to do with this overage would be to allow the company to offer the bonds at the market rate, but mandate that the company hold the difference between the agreed price and the spot price in an escrow account, payable to the host institution of the first group who 26 conduct the relevant definitive trial.